The influence of corruption and governance in the delivery of frontline health care services in the public sector: a scoping review of current and future prospects in low and middle-income countries of south and south-east Asia

Abstract

Background The dynamic intersection of a pluralistic health system, large informal sector, and poor regulatory environment have provided conditions favourable for ‘corruption’ in the LMICs of south and south-east Asia region. ‘Corruption’ works to undermine the UHC goals of achieving equity, quality, and responsiveness including financial protection, especially while delivering frontline health care services. This scoping review examines current situation regarding health sector corruption at frontlines of service delivery in this region, related policy perspectives, and alternative strategies currently being tested to address this pervasive phenomenon. Methods A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was conducted, using three search engines i.e., PubMed, SCOPUS and Google Scholar. A total of 15 articles and documents on corruption and 18 on governance were selected for analysis. A PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist was filled-in to complete this report. Data were extracted using a pre-designed template and analysed by ‘mixed studies review’ method. Results Common types of corruption like informal payments, bribery and absenteeism identified in the review have largely financial factors as the underlying cause. Poor salary and benefits, poor incentives and motivation, and poor governance have a damaging impact on health outcomes and the quality of health care services. These result in high out-of-pocket expenditure, erosion of trust in the system, and reduced service utilization. Implementing regulations remain constrained not only due to lack of institutional capacity but also political commitment. Lack of good governance encourage frontline health care providers to bend the rules of law and make centrally designed anti-corruption measures largely in-effective. Alternatively, a few bottom-up community-engaged interventions have been tested showing promising results. The challenge is to scale up the successful ones for measurable impact. Conclusions Corruption and lack of good governance in these countries undermine the delivery of quality essential health care services in an equitable manner, make it costly for the poor and disadvantaged, and results in poor health outcomes. Traditional measures to combat corruption have largely been ineffective, necessitating the need for innovative thinking if UHC is to be achieved by 2030.

COVID-19 Pandemic Is About More than Health: A State of Governance Challenges in Bangladesh

“…The government has also proposed Tk.100,000 million to deal with any acute health crisis, and Tk.1,000 million has also been planned to help improve research in the health education and science technology areas (TBS, 2020). Corruption is a natural effect of poor governance, and the issue of corruption in the health sector is widespread in Bangladesh (Naher et al, 2020; Rose et al, 2014). Kirya (2020) argues that ‘anti-corruption, transparency and accountability’ (p. 1) are crucial to constructing healthy, resilient and inclusive society.…”

Health systems trust in the time of Covid-19 pandemic in Bangladesh: A qualitative exploration

“…A study by Transparency International identifies major health sector irregularities, which include politically influenced recruitment, transfers and promotions of healthcare professionals, irregularities in the procurement of drugs and equipment, unregistered and unqualified doctors operating in private healthcare facilities, and absenteeism 31 . A recent article, drawing examples from the Ebola crisis in Africa, demonstrated, how corruption erodes trust in the health system to the detriment of overall population health 32 . It was evident from the remarks of the respondents that the lack of coordination and leadership in pandemic response led to mistrust and subsequent consequences, such as social stigma, psychological impact, and further spread of the disease.…”

Why Is Family-Oriented Organ Transplantation Policy and Practice Necessary for Bangladesh?

“…In addition to the poor socio-economic conditions of people in Bangladesh, I also argue that allowing unrelated donors to donate organs lawfully will severely increase organ trading in Bangladesh, where there is no effective accountability mechanism, and corruption has been a burden for many years 28 . For instance, in 2012, TI ranked Bangladesh as the thirteenth most-corrupted country in the world 29 .…”